Evidence map›Paper›PMID 32375684›Full record

Trial reportBMC pregnancy and childbirth2020

Health management committee strengthening and community mobilisation through women's groups to improve trained health worker attendance at birth in rural Nepal: a cluster randomised controlled trial.

Joanna Morrison, Kirti Tumbahangphe, Aman Sen, Lu Gram, Bharat Budhathoki, Rishi Neupane, Rita Thapa, Kunta Dahal, Bidur Thapa, Dharma Manandhar and 2 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC pregnancy and childbirth, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 5 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Joanna MorrisonInstitute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. Joanna.morrison@ucl.ac.uk.ORCID http://orcid.org/0000-0002-9241-8863
Kirti TumbahangpheMother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal.
Aman SenMother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal.
Lu GramInstitute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
Bharat BudhathokiMother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal.
Rishi NeupaneMother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal.
Rita ThapaMother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal.
Kunta DahalMother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal.
Bidur ThapaMother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal.
Dharma ManandharMother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal.
Anthony CostelloInstitute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
David OsrinInstitute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.

Funding

Wellcome Trust 085417MA/Z/08/Z
6 · The paper itself

Abstract

backgroundEngaging citizens and communities to make services accountable is vital to achieving health development goals. Community participation in health management committees can increase public accountability of health services. We conducted a cluster randomised controlled trial to test the impact of strengthened health management committees (HMCs) and community mobilisation through women's groups on institutional deliveries and deliveries by trained health workers in rural Nepal.

methodsThe study was conducted in all Village Development Committee clusters in the hills district of Makwanpur (population of 420,500). In 21 intervention clusters, we conducted three-day workshops with HMCs to improve their capacity for planning and action and supported female community health volunteers to run women's groups. These groups met once a month and mobilised communities to address barriers to institutional delivery through participatory learning and action cycles. We compared this intervention with 22 control clusters. Prospective surveillance from October 2010 to the end of September 2012 captured complete data on 13,721 deliveries in intervention and control areas. Analysis was by intention to treat.

resultsThe women's group intervention was implemented as intended, but we were unable to support HMCs as planned because many did not meet regularly. The activities of community based organisations were systematically targeted at control clusters, which meant that there were no true 'control' clusters. 39% (5403) of deliveries were in health institutions and trained health workers attended most of them. There were no differences between trial arms in institutional delivery uptake (1.45, 0.76-2.78) or attendance by trained health workers (OR 1.43, 95% CI 0.74-2.74).

conclusionsThe absence of a true counterfactual and inadequate coverage of the HMC strengthening intervention impedes our ability to draw conclusions. Further research is needed to test the effectiveness of strengthening public accountability mechanisms on increased utilisation of services at delivery.

trial registrationCurrent Controlled Trials ISRCTN99834806. Date of registration:28/09/10.

Indexed as

Rural PopulationWomenAdolescentAdultChildCluster AnalysisCommunity Health WorkersCommunity ParticipationDelivery, ObstetricDeveloping CountriesFemaleHealth Services AccessibilityHumansMaternal Health ServicesMiddle AgedNepalHealth systemsMaternalNewbornParticipationPublic accountabilitySouth Asia

Identifiers

PMID32375684
PMCPMC7201973

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.